RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2012-01172
BRANCH OF SERVICE:  Army	BOARD DATE:  20150227
SEPARATION DATE:  20030716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Cannon Crewmember) medically separated for a chronic left knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left knee pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain attributed to tendonitis” as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals at that and was medically separated.

CI CONTENTION:  “Consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left knee condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any condition outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

IPEB – Dated 20030521 | VA* – based on Service Treatment Record (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Left Knee Pain | 5099-5003 | 0% | Retropatellar Pain Syndrome, Left Knee | 5299-5261 | NSC | STR
Other x 0 (Not In Scope) | Other x 0
RATING:  0% | RATING:  No Rating
*Derived from VA Rating Decision (VARD) dated 20040405 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Left knee pain.  This CI started having knee pain in October 2001.  He was treated with ice, medication, and activity modification.  The CI did note some improvement.  When he started Airborne training, his knee pain got worse due to increased running.  Over the months that followed, many different treatment modalities were tried.  However, the left knee pain persisted and an MEB was initiated.  The MEB physical exam was in March 2003.  The CI was alert, and in no acute distress.  Gait was normal, but he did have some difficulty performing squats.  There was tenderness to palpation on the lateral aspect of the left knee.  Knee range-of-motion was not recorded.  In February 2004, 7 months after separation, he was scheduled to have a VA Compensation and Pension exam, but failed to appear for that evaluation.
The Board directed its attention to its rating recommendation based on the above evidence.  The Army PEB and the VA chose different coding options for the left knee condition.  The PEB used diagnostic code 5099-5003 (analogous to degenerative arthritis).  The VA coded it 5299-5261 (analogous to limitation of leg extension).  The Board determined that the left knee condition was essentially non-compensable based on the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.71a codes for the knee and leg (5256 through 5263).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no path to a higher rating for the left knee since there was insufficient evidence of a significantly disabling knee abnormality that would justify a higher rating.  After due deliberation, the Board determined that a disability rating of 10% was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a 10% disability rating for the chronic unfitting left knee pain.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As noted above, PEB reliance on the USAPDA pain policy may have been operant in this case.  The knee condition was adjudicated independently of that policy by this Board.  In the matter of the chronic left knee pain, the Board unanimously recommends a disability rating of 10%, coded 5299-5261, IAW VASRD §4.40, §4.45, and §4.59.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION | VASRD CODE | RATING
Chronic left knee pain | 5299-5261 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			XXXXXXXXXXXXXXX
			President 
			Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150007424 (PD201201172)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			     XXXXXXXXXXXXXXX
				     Deputy Assistant Secretary of the Army
				         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD-2012-01172